A Confusing Set of Xrays
Article Outline
[Ann Emerg Med. 2009;53:545.]
A 25-year-old man of Caribbean descent was pulled from the Hudson River after fleeing from the police on a cold spring night. On examination, he was noted to have a respiratory rate of 18 breaths/min, with 96% oxygen saturation on room air. He was lethargic and minimally responsive to commands, with clear lungs to auscultation bilaterally. The portable chest radiograph (Figure 1) was obtained in the course of his evaluation.
Figure 1.
Portable chest radiograph.
Diagnosis
Hair artifact. Despite the reassuring physical examination results, the portable chest radiograph prompted a differential that included aspiration pneumonitis and early acute respiratory distress syndrome. Because the patient was stable, he was sent to radiology for a formal posterior-anterior radiograph (Figure 2).
Figure 2.
Posterior-anterior chest radiograph.
On realizing the discrepancy between radiographs, the radiology technician who performed the initial portable radiograph admitted the patient was uncooperative and the plate had been positioned behind his long, braided hair. His head computed tomography (CT) scan (Figure 3) confirmed our suspicion that dreadlocks were obscuring his lung fields.
Figure 3.
Head CT showcasing the patient's radiopaque hairstyle. Used with permission of Nicholas Genes, MD, PhD, Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY.
Hair artifact is commonly encountered in the dental literature1 and has been described in chest radiography,2 in which braided hair has been confused for tuberculosis.3 This phenomenon is rarely observed in hospitals because of the strict protocols followed by radiology technicians. However, in an emergency department with uncooperative patients, it is sometimes difficult to obtain proper positioning and preparation before chest radiography. Emergency physicians should remain vigilant, especially when there is disagreement between radiologic findings and physical examination results.
References
For the diagnosis and teaching points, see page 573.
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PII: S0196-0644(08)01718-6
doi:10.1016/j.annemergmed.2008.08.031
© 2008 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
